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UNRS 113 > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

What is hemostasis?

A

The process that stops bleeding after injury to a blood vessel

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2
Q

What are the 2 stages of hemostasis?

A

1) Formation of a platelet plug

2) Reinforcement of the platelet plug with fibrin

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3
Q

What is coagulation?

A

The process of blood clot formation

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4
Q

What is a thrombus?

A

Intravascular blood clot

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5
Q

What is an embolus?

A

A thrombus that travels from its site of origin

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6
Q

What is the coagulation cascade?

A

The series of steps of coagulation that is like a domino effect because each activated clotting factor serves as a catalyst that initiates the next reatcion

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7
Q

What is the end result of the coagulation cascade?

A

Large concentration of fibrin

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8
Q

What is fibrin?

A

Clot forming substance

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9
Q

What are anticoagulants?

A

Substances that prevent the formation of clotting factors, which prevents clot from forming

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10
Q

What are antiplatelet drugs?

A

Substances that inhibit platelet aggregation (buildup)

Prevents platelet plug

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11
Q

What are thrombolytic drugs?

A

Substances that lyse (break down) existing clots

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12
Q

What are the drug subclasses of anticoagulants?

A

Heparin (Low Molecular Weight Heparin - LMWH)

Warfarin (Coumadin)

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13
Q

What is the mechanism of action of heparin?

A

Binds to antithrombin III which turns off 3 main activating factors (II, IX, X).
Turns off coagulation pathway and prevents clots from forming

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14
Q

What are the nursing implications for heparin?

A

Parenteral
Anticoagulation effects seen immediately
Short half-life (1-2 hours)
Monitored by activated partial thromboplastin times (aPTT)

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15
Q

What is the antidote for heparin?

A

Protamine sulfate

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16
Q

What are adverse effects of heparin?

A

Bleeding

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17
Q

What is activated partial thromboplastin time (aPTT) used for?

A

aPTT measures how long it takes for a clot to form in a sample of blood

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18
Q

What is a normal result of aPTT?

A

40 seconds

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19
Q

What is a normal therapeutic result of aPTT?

A

1.5 - 2.0 times normal

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20
Q

What is important to note about the administration of heparin?

A

It is a double-check medication

2 RNs must verify that this medication is administered correctly

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21
Q

What is the mechanism of action of low molecular weight heparins?

A

Synthetic with smaller molecular structure than normal heparins
More specific for factor X
Has a more predictable anticoagulant response

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22
Q

What are the nursing implications for low molecular weight heparins?

A

Does not require lab monitoring

Administered subcutaneously in abdomen

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23
Q

What are some low molecular weight heparins?

A

Enoxaparin (Lovenox)

Dalteparin (Fragmin)

24
Q

What is the antidote for low molecular weight heparin?

A

Protamine sulfate

25
Q

What is protamine sulfate used for?

A

Antidote used in case of excessive anticoagulation

26
Q

What is the mechanism of action of warfarin?

A

Inhibits GI tract bacterial synthesis of vitamin K, which inhibits production of clotting factors II, VII, IX, and X
Prevents clot formation

27
Q

What are the nursing implications for warfarin?

A

Administered orally

Monitored by prothrombin time (PT) and international normalized ratio (INR)

28
Q

What is the antidote for warfarin?

A

Vitamin K

29
Q

What is a warfarin drug?

A

Warfarin (Coumadin)

30
Q

What is prothrombin time (PT) used for?

A

Measures how long it takes a clot to form in a sample of blood

31
Q

What is a normal result of prothrombin time?

A

11 - 15 seconds

32
Q

What is international normalization rate (INR) used for?

A

Used as a standardized measure of coagulation achieved by drug therapy

33
Q

What is a normal result of INR?

A

1.0

34
Q

What is a therapeutic Coumadin INR level?

A

2.0 - 3.0

35
Q

What are the nursing implications for warfarin?

A

May be started while the patient is still on heparin until PT-INR levels indicate adequate anticoagulation
Full therapeutic effect takes several days
Monitor PT-INR regularly
Vitamin K is the antidote

36
Q

What is the antidote for warfarin?

A

Vitamin K

37
Q

Between heparin and coumadin, which works faster?

A

Heparin works immediately, faster than coumadin

38
Q

What are some things to educate the patient about warfarin?

A 
Take exactly as directed
If dose is missed, take asap
Do not double up on doses
Review food high in vitamin K
Must keep follow up appointments
Use soft brush for brushing teeth
Report any unusual bleeding/bruising
39
Q

Which foods are rich in vitamin K?

A

Dark green leafy vegetables

40
Q

What are adverse effects of anticoagulants?

A 
Bleeding
Nausea
Vomiting
Abdominal cramps
Thrombocytopenia
41
Q

What are the contraindications of anticoagulants?

A 
Severe uncontrolled hypertension
Hemorrhagic stroke
Bleeding disorders
GI bleeding/ulcers
Recent spinal cord surgery
Opthalmologic surgery
42
Q

What are some things to educate the patient about anticoagulants?

A

Importance of regular lab testing
Signs of abnormal bleeding
Measures to prevent bruising, bleeding, or tissue injury
Wearing a medical alert bracelet
Consulting physician before taking other meds

43
Q

What are antiplatelet drugs?

A 
Aspirin
Clopidogrel (Plavix)
44
Q

What is the mechanism of action/drug effect of aspirin?

A

Results in dilation of blood vessels and prevention of platelets from aggregating or forming a clot
Has analgesic, antiinflammatory, and antipyretic properties
Has antiplatelet effects

45
Q

What are the indications for aspirin?

A

Stroke prevention

46
Q

What are the contraindications for aspirin?

A 
Flu like symptoms in children and teenagers (Reye's syndrome)
Allergy
Thrombocytopenia
Active bleeding
Leukemia
Traumatic injury
Gastrointestinal ulcer
Vitamin K deficiency
Recent stroke
47
Q

What are the adverse effects of aspirin?

A

Drowsiness, dizziness, confusion, flushing
Nausea, vomiting, gastrointestinal bleeding
Thrombocytopenia, agranulocytosis, leukopenia, neutropenia, hemolytic anemia, bleeding

48
Q

What are the mechanism of action/drug effects of clopidogrel (plavix)?

A

Alters platelet membrane so that it can no longer receive the signal to aggregate and form a clot

49
Q

What are the indications of clopidogrel (plavix)?

A

Reduce risk for thrombotic stroke

50
Q

What are the contraindications of clopidogrel (plavix)?

A 
Allergy
Thrombocytopenia
Active bleeding
Leukemia
Traumatic injury
Gastrointestinal ulcer
Vitamin K deficiency
Recent stroke
51
Q

What are the adverse effects of clopidogrel (plavix)?

A

Chest pain, edema
Flu like symptoms, headache, dizziness, fatigue
Abdominal pain, diarrhea, nausea
Epistaxis, rash, and pruritus

52
Q

What are the nursing implications of clopidogrel (plavix)?

A

Oral use only

Black box warning - genetic abnormalities may ave a higher rate of cardiovascular events

53
Q

What are the signs and symptoms of bleeding?

A 
Bleeding gums
Nose bleed
Unusual bleeding
Excessive bruising
Black tarry stools
Hematuria
Fall in hematocrit
Elevated PT
54
Q

What are the characteristics of urine output from anticoagulants?

A

Serosanguineous

Sanguineous

55
Q

What is serosanguineous?

A

Clear, watery, and tinged pink or pale red, denoting presence of blood

56
Q

What is sanguineous?

A

Bloody, indicating active bleeding

UNRS 113 (4 decks)

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